tbuckley/cabot-search huggingface dataset:
Abstract 11680: Modified versus Standard Endomyocardial Biopsy Technique: A Comparison of Fluoroscopy Time, Total Procedure Time, and Complications
Authors: Scott Rizzi, Ethan Krauspe, Chong Zhang, Charles Lui
Journal: Circulation (2022)

Background: Patients who have undergone orthotopic heart transplant (OHT) undergo frequent endomyocardial biopsies (EMBx) to assess for rejection. Difficulty crossing the superior venous caval anastomosis and tricuspid valve often complicates these procedures. We studied a new approach in which a peel-away sheath is placed in the right internal jugular vein through which a Swan-Ganz catheter is then inserted and advanced. Following right heart catheterization, the peel-away sheath is removed and a long biopsy sheath is advanced over the Swan-Ganz catheter, which is then removed, leaving the long sheath behind for advancement of the bioptome into the right ventricle. Objective: To compare fluoroscopy (fluoro) time, procedure time, and complications between a modified and standard approach to EMBx. Methods: We included patients who underwent OHT and had EMBx data available for review at two University-affiliated institutions. We excluded EMBx cases that combined a left heart catheterization. We compared fluoro time and procedure time between modalities using mixed effects gamma regression with operators and patients both included as random effects. Results: We analyzed 964 (198 modified, 766 standard) EMBx cases in 71 patients who underwent OHT from 2017 to 2022. The mean patient age was 53.9 at time of OHT; 14% (n=10) were female. Median fluoro time was 2.8 and 4.9 minutes, and median procedure time was 27 and 29 minutes, for the modified and standard approach, respectively. Cases performed using the modified approach had a shorter fluoro time by 28%, and a shorter procedure time by 7% as compared to the standard approach (Ratio=0.72, 95% CI: 0.62 ~ 0.84, p&lt;0.001 for fluoro time; Ratio=0.93, 95% CI: 0.87 ~ 0.98, p=0.014 for total procedure time). Only one complication was identified. Conclusion: In this cohort, a modified approach to EMBx was associated with reduced fluoroscopy and procedure time as compared to the standard approach with no difference in complications.
Abstract 11983: Associations Between Circulating Proteins and Intracardiac Immune Populations in Immune Checkpoint Inhibitor-Associated Myocarditis
Authors: Daniel Zlotoff, Steven Blum, Swetha Ramesh, Isabela Kernin, Neal Smith, Pritha Sen, Leyre Zubiri, Alice Tirard, Mazen Nasrallah, Jessica Tantivit, Kasidet Manakongtreecheep, Benjamin Arnold, PuiYee Chan, Jaimie Barth, Dejan Juric, Ryan Sullivan, Genevieve Boland, Mari Mino-Kenudson, James R Stone, Molly F Thomas, Joshua Caplin, Kerry Reynolds, Tomas G Neilan, Alexandra-Chloe Villani
Journal: Circulation (2022)

Introduction: Myocarditis due to immune checkpoint inhibitors (ICIs), a type of cancer immunotherapy, is associated with high morbidity and mortality. The cellular and molecular pathogenesis of ICI myocarditis remains largely unknown. Identification of circulating factors associated with intracardiac pathology may aid new clinical approaches. Hypothesis: We hypothesized that ICI myocarditis is associated with increased abundance of intracardiac immune cells and upregulated inflammatory genes in the heart and serum. Methods: Heart tissue from 13 patients with ICI myocarditis was acquired by endomyocardial biopsy or autopsy; peripheral blood mononuclear cells (PBMCs) were also collected from ten of these patients and eight additional ICI myocarditis patients. Control heart tissue was derived from six hearts declined for transplantation (non-ICI-exposed) and from the biopsy and autopsy of one ICI-treated patient without myocarditis. The 10x Genomics Chromium system was used to generate single-cell RNA sequencing (scRNAseq) data from heart and PBMC specimens. Serum proteins were measured by core lab assay (for troponin T) or by multiplexed Luminex immunoassay. Results: Unbiased clustering of scRNAseq data from 77,071 cells recovered from heart samples revealed 37 cell subsets across 10 cell lineages. Myocarditis heart tissue demonstrated enrichment of T/NK cells (odds ratio 8.3, p=0.0006), B/plasma cells (OR 5.1, p=0.01), and dendritic cells (DCs) (OR 9.2, p=0.006) relative to controls. Circulating DC abundance was decreased in fatal (n=3) versus nonfatal (n=15) myocarditis cases (p=0.008), while intracardiac DC abundance was directly associated with serum troponin T values (p=0.02). The levels of five immunomodulatory factors - IL-15, CXCL9, CCL3, TNFα, and CCL21 - were found to be significantly upregulated transcriptionally in at least one intracardiac cell subset and at the protein level in the serum of myocarditis cases. Conclusions: Fatality status and troponin level associated with intracardiac DC abundance and multiple immunomodulatory genes were upregulated in both the heart and serum in ICI myocarditis. These observations may guide novel diagnostic and therapeutic strategies.
Abstract 11924: Nicorandil Attenuates Ventricular Dysfunction in a Piglet Model of Cardiopulmonary Bypass and Cardioplegic Arrest
Authors: Yunwen Peng, Bailey Schneider, Matthew Johnson, McKenzie Hayes, Lise Tchouta, John Toomasian, Alvaro Rojas-Pena, John R Charpie
Journal: Circulation (2022)

Introduction: Nicorandil is a coronary vasodilator for treatment of ischemia-induced angina. Studies suggest nicorandil may offer myocardial protection against regional ischemia-reperfusion (IR) injury during coronary artery bypass grafting in adults. The impact of nicorandil on global IR-induced myocardial injury and left ventricular (LV) dysfunction after cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) has not been investigated in children. Hypothesis: Nicorandil attenuates myocardial IR injury and LV dysfunction after CPB and CA in an immature animal model. Methods: Anesthetized piglets (4-5 weeks-old, 8.8±0.4 kg) were cannulated via the right atrium and ascending aorta for initiation of full-flow CPB (100 mL/kg/min). Following 30 mins of aortic cross-clamp (ACC) and CA, hearts were reperfused on full CPB for 60 mins, followed by partial CPB for 30 mins, and separation from CPB for 30 mins. Nicorandil (0.2 mg/kg IV bolus + 0.02 mg/kg/min IV continuous infusion) or saline (N=6 per group) was initiated 5 mins before ACC and continued throughout the protocol. Temperature, ECG, mean arterial pressure (MAP), and LV function (via high-fidelity Millar pressure catheter) were continuously recorded. Serial plasma samples were collected for measurement of oxidant stress, inflammation, and multi-organ injury (heart, lung, kidney, and brain). Results: Temperature, heart rate, and MAP were similar between nicorandil- and saline-treated groups. However, 120 mins after ACC removal, nicorandil treatment significantly improved LV contractility [LV +dP/dt: 2,962±678 mmHg/sec (nicorandil) vs. 1,278±332 mmHg/sec (saline), p=0.004] and LV relaxation [LV -dP/dt: -2,670±454 mmHg/sec (nicorandil) vs. -1,347±339 mmHg/s (saline), p=0.002]. Also, nicorandil significantly attenuated the IR-induced increase in circulating biomarkers for oxidant stress, inflammation, and multi-organ injury. Conclusions: In a piglet model of CPB with CA, nicorandil attenuates LV systolic and diastolic dysfunction and improves oxidant stress, inflammation, and multi-organ injury. These results suggest that nicorandil may prove beneficial to mitigate IR injury and accelerate LV functional recovery after open heart surgery in infants and children.
Abstract 12167: High BNP and NT-proBNP Level as a Poor Prognostic Indicator an Patients With Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis
Authors: Sandeep Singh, Mohan Chandra Vinay Bharadwaj Gudiwada, Vinuthna Gaddam, Mohammad Ali Mozaffari, Nazanin AHMADZADEH, Hanieh Akbariromani, Ayodya Perera, Hamna Naseem, Chetan Reddy Lankala, Akhil Jain, Rupak Desai
Journal: Circulation (2022)

Background: Raised BNP/NT-pro BNP has been reported as a poor prognostic indicator in hypertrophic cardiomyopathy (HCM) patients. However, the unavailability of pooled data utilizing BNP/NT-proBNP as a prognostic biomarker led us to perform this systematic review and meta-analysis. Methods: Using relevant keywords, PubMed/Medline, Scopus, and EMBASE were systematically reviewed to evaluate studies reporting all-cause mortality or sudden death with BNP/NT-pro BNP through May 2022. Random effects models and I 2 statistics were used for pooled hazard ratios (HR) and heterogeneity assessment using Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020. Results: Our systematic review included sample size of 6691 from 12 studies [Table 1]. Four publications were from China, 2 from Japan and Turkey each and 1 from USA, UK, Italy and France each. Age ranged from 46-55 years with a follow up time from 3-8 years. High NT-proBNP was associated with significantly high risk of all-cause mortality in both unadjusted (HR 1.69, 95%CI: 1.30-2.20, p&lt;0.05, I 2 =90%) and adjusted models (HR 3.73, 95%CI: 1.36-10.21, p&lt;0.05, I 2 =83%), and of sudden death in adjusted (HR 4.78, 95%CI: 1.49-15.34, p&lt;0.05, I 2 =89%). Raised BNP level was associated with adjusted sudden death (HR 5.10, 95%CI: 3.03-8.61, p&lt;0.05) (Fig. 1). Conclusions: This meta-analysis suggested that higher BNP/NT-proBNP level was associated with high risk of combined all-cause mortality and sudden death in patient with hypertrophic cardiomyopathy.
Abstract 12259: Recurrent Coronary Artery Dissection in Patient With Systemic Medium-Sized Vessel Vasculitis
Authors: MICHAEL D MURPHY, Timothy Fitzgibbons
Journal: Circulation (2022)

Introduction: Universal definition of myocardial infarction (MI) categorizes spontaneous coronary artery dissection (SCAD) as Type 2 ischemia from non-atherothrombotic obstruction. SCAD is rare but growing evidence suggests it is more common than previously understood. Overlap in clinical presentation with Type 1 MI makes invasive coronary angiography (ICA) the gold standard for diagnosis. Here we present a patient with polyarteritis nodosa (PAN) and the sequelae of coronary artery aneurysms and dissections visualized by ICA and further characterized by noninvasive coronary computed tomography angiography (CCTA). Case Report: A 37-year-old man with smoking and hypertension history presented with acute chest pain that felt similar to when he was diagnosed with SCAD of the first diagonal branch one year prior by ICA. Workup then included elevated inflammatory markers and further imaging demonstrating ectatic and beaded-appearing major intra-abdominal and vertebral arteries consistent with PAN. He completed outpatient cyclophosphamide and continued on chronic oral steroids.The catheterization lab was activated on this presentation for ST segment elevations on initial ECG concerning for an inferior MI. Here the distal branches of the right coronary artery (RCA) had new aneurysms and long stenoses with severe luminal narrowing and intramural hematoma consistent with Type 2 SCAD. The culprit lesions had normal TIMI grade 3 flow so were not revascularized. CCTA further characterized the filling defect and RCA false lumen as Type 1 SCAD. Echocardiogram demonstrated a new wall motion dysfunction in correlative distribution. He was optimized on medical therapy including continued dual antiplatelet agents and steroids. Discussion: This patient’s case lends itself to the hypothesis that his PAN manifested ectatic changes to the coronary vasculature from inflammation that predisposed him to recurrent dissection. Therefore, it is reasonable to initiate a vasculitis workup following discovery of coronary artery ectasia and/or dissection. CCTA may even be an effective tool for diagnosis and surveillance of such disease in the right patient and as a means to avoid invasive testing risks.
Abstract 11774: Heart Failure With Preserved Ejection Fraction Secondary to Coronary Endothelial Dysfunction and Microvascular Disease
Authors: Muhammad Ajmal, Saad Kubba, Kwan Seung S Lee, Amir Lerman, Michel Corban
Journal: Circulation (2022)

A 41-year-old female with hyperlipidemia presented with typical exertional angina, dyspnea, and pre-syncope of 6 months duration. Physical examination was unremarkable. ECG showed low voltage QRS (Figure A), and Chest CTA was negative for obstructive-CAD, pulmonary emboli, aortic, and lung disease. Cardiac MRI was negative for myocarditis/pericarditis . Resting TTE was unremarkable with normal systolic and diastolic function. NT-Pro BNP, hs-CRP, serum/ urine protein electrophoresis, and free light chains ratio were normal. Regadenoson PET myocardial perfusion test showed a medium-sized area of stress-induced ischemia in mid/apical segments (Figure B) . Resting right heart Cath showed mean RA pressure (9mmHg) and RVEDP (10mmHg), mean PA pressure (19mmHg), and PCWP (15mmHg) with large v-waves, PCWP increased to 28mmHg with limited supine bike exercise, diagnostic of HFpEF (Figure C) . Angiography showed normal coronary arteries while coronary reactivity testing was diagnostic of severe epicardial and microvascular endothelial dysfunction (60% mid/distal LAD constriction and 19% decreased blood flow in response to intracoronary (IC) acetylcholine), and endothelial-independent microvascular dysfunction (coronary flow reserve 2.4 in response to IC adenosine), diagnostic of HFpEF due to coronary endothelial and microvascular disease (Figure D) . The patient’s symptoms improved at 2 weeks follow-up after initiation of furosemide, diltiazem, isosorbide mononitrate, and atorvastatin.
Abstract 11439: Predictors of Long-Term Heart Failure Readmissions Following PCI in Women
Authors: Michelle Morris, Elisabeth von der Lohe, Rolf Kreutz
Journal: Circulation (2022)

Introduction: Heart failure (CHF) is a common cause of readmission following percutaneous coronary intervention (PCI), particularly within the first 30 days. Female sex has been shown to be an independent predictor of 30-day readmission following PCI, with higher rates of readmission secondary to CHF observed in women. Whether the increased risk for CHF readmission persists beyond this early period has not been well studied. Methods: In this multicenter, retrospective observational study clinical outcomes were analyzed after PCI among patients included in the Indiana University Health Multicenter Cath Registry Study. Hospital readmission for acute CHF was the primary endpoint and analyzed through use of the Indiana network for patient care. Results: Among 13,871 patients included in this study, 14.5% were readmitted for CHF after the index PCI during mean follow up of 2.8 years. Women (n=4,411) were more likely to be readmitted for CHF than men (n=9,460) [HR 1.37,95% CI: 1.26-1.5; p&lt;0.001). Women were older than men (66.1 vs. 63.8 years, p&lt;0.001) and more likely to have diabetes (49% vs. 41%, p&lt;0.001). Female sex persisted as independent predictor of CHF readmission after multivariate adjustment (p=0.004). The higher rate of CHF readmission in women continued to accrue beyond 30 days and event curves continued to diverge over the duration of follow up (Fig.).] Major predictors of CHF readmission included end stage renal disease, cardiogenic shock during index PCI, mechanical ventricular support at time of PCI, diabetes mellitus, and history of COPD, whereas discharge with ACEI or ARB was protective. Conclusions: Heart failure readmission remains a major cause of morbidity for women after undergoing PCI. The excess risk of CHF readmission in women extends beyond the early 30-day post PCI period.
Abstract 11505: Predicting In-Hospital All-Cause Mortality in Chronic Total Occlusion Percutaneous Coronary Intervention: PROGRESS-CTO Mortality Score
Authors: Bahadir Simsek, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Oleg Krestyaninov, Dmitrii Khelimskii, Rhian Davies, OMER GOKTEKIN, Sevket Gorgulu, Ahmed El Guindy, Raj Chandwaney, MITUL P PATEL, Dimitrios Karmpaliotis, Jaikirshan Khatri, Farouc A Jaffer, Bavana V Rangan, Yader Sandoval, James Choi, William Nicholson, Wissam Jaber, Stephane Rinfret, MICHAEL KUTUZIS, Ioannis Tsiafoutis, Robert W Yeh, M Nicholas Burke, Salman S Allana, Olga Mastrodemos, Emmanouil S Brilakis
Journal: Circulation (2022)

Introduction: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with increased risk of periprocedural complications. Estimating the risk of complications facilitates risk-benefit assessment and procedural planning. Methods: We analyzed the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO, NCT02061436) and created a risk score for in-hospital all-cause mortality. Logistic regression prediction modeling was used to identify independently associated variables and the model was internally validated with bootstrapping. Results: Of the 10,480 CTO PCI cases performed between 2012-2022 at 40 US and non-US centers, in-hospital mortality occurred in 47 (0.45%). The final prediction model identified 4 independent predictors of mortality: Age ≥65 years, Odds Ratio [OR]: 2.83 (95% confidence interval [CI], 1.30-6.16), 1-point; Left ventricular ejection fraction ≤45%, OR: 2.13 (95% CI, 1.14-3.98), 1-point; Moderate-severe calcification, OR: 2.45 (95% CI, 1.18-5.08), 1-point; and Antegrade dissection re-entry, OR: 2.81 (95% CI, 1.06-7.43), 1-point; or Retrograde strategy, OR: 3.51 (95% CI, 1.67-7.37), 1-point; with a bootstrap corrected c-statistics of 0.71 (95% confidence interval: 0.63-0.81). The calculated risk percentages for mortality based on the PROGRESS-CTO mortality score ranged from 0.05-2.42% for mortality, and 63% of patients in the PROGRESS-CTO cohort had PROGRESS-CTO mortality score of 1 or 2, corresponding to a mortality risk of 0.1-0.5% (Figure 1). Conclusions: The PROGRESS-CTO in-hospital mortality risk score can facilitate risk-benefit assessment and procedural planning in patients undergoing CTO PCI.
Abstract 12373: Process Evaluation of a Vanguard Phase of a Trial for a Smartphone- App Based Model Of Care
Authors: Eleanor Redwood, Praveen Indraratna, Jennifer Yu, Kim Delbaere, Nigel H Lovell, Sze Yuan M Ooi, Hueiming Liu
Journal: Circulation (2022)

Background: Home-based monitoring and timely intervention of patients with acute coronary syndrome (ACS) and heart failure (HF) can improve patient outcomes. TeleClinical Care (TCC-Cardiac) is a smartphone app-based model of care designed to improve community-based care. We conducted a process evaluation within a multi-centre RCT to elucidate barriers and facilitators to implementation. Methods Patients were enrolled during their hospital stay and provided with an app and Bluetooth observation monitors. Patients were encouraged to engage with the app regularly (i.e. exercise program, record their observations). Data were monitored by a dedicated Remote Monitoring Solution team (RMS), and information was made available to the care team. Interviews were conducted with patients at 6 months, and with 3 RMS members, 2 HF nurses and 1 cardiologist. Results Of the 35 enrolled patients, 27 (77%) had a diagnosis of ACS and 8 (23%) of HF. Patient engagement with the app was good overall, with adherence tailing off over time, demonstrated by median (IQI) patient self-BP recordings of 93.3% (90-100%) at 1-month compared to 70% (43-90%) at 6-months. Older patients had higher levels of adoption (&gt;50%), with a median age amongst high adopters of 67-years (IQI 40-82) compared to 63-years (IQI 50-87) for medium adopters (50-70%) and 44-years (IQI 33-53) amongst low adopters (&lt;50%) (p=0.0184) (Fig 1). Interviews revealed good acceptance of Telehealth and remote monitoring. Higher motivation and health and tech literacy facilitated adherence. 21% of participants meeting inclusion criteria but not enrolled did not possess a smartphone. GPs did not engage. Other health professionals identified the time requirements of supporting less tech-literate patients and responding to alerts as potential barriers to adoption. However, most valued the potential for early detection and prevention of deterioration of this cohort of patients. Conclusion TCC-cardiac was generally considered an acceptable and viable model of care by patients and health professionals. Adherence was best amongst older patients with the highest potential to benefit. Designing strategies to overcome barriers to adherence in younger patients and GPs, combined with adequate tech support is recommended.
Abstract 12519: Derivation of Coronary Age Based on Coronary Artery Calcification Score Compared to Chronological Age
Authors: Adel Hajj Ali, Michael Nakhla, Leslie Cho, Raul Seballos, Richard S Lang, Steven Feinleib, Scott D Flamm, Paul SCHOENHAGEN, Tom Kai Ming K Wang, Milind Y Desai
Journal: Circulation (2022)

Introduction: Besides reporting conventional calcium score, coronary age was suggested as an original function of cardiovascular risk. Hypothesis: In a primary prevention cohort, we sought to assess the reclassification provided by coronary arterial age derived from the Multi-Ethnic Study of Atherosclerosis- coronary artery calcification 10-year risk score (MESA-CACS). Methods: Consecutive patients (n=5324 ,age 57± 8 years ,76% male and 87% white) undergoing CACS screening in a primary prevention clinic between 3/2016 and 10/2021 were retrospectively included in this study. Coronary arterial age was calculated for the patients using the formula provided by Blaha M et al 2021 by solving for age from MESA-CACS 10-year risk = 1–0.99963exp(0.04555*Age+2.45). Results: The distribution of the difference between the calculated coronary age and the chronological age is presented in Fig 1a, with 1823 (62%) patients with CAC of 0 being downgraded by &gt;20 years and 298 (29%) of patients with CAC &gt;75 th percentile being upgraded by &gt;20 years. The average difference between coronary age and chronological age (years) across the CAC percentile groups is -23.7, -18.3, -7.4, -0.2 and +12.8 years for CAC of 0, 1-25, 26-50, 51-75 and &gt;75 th percentile, respectively (Figure 1b). Conclusions: The use of coronary age is a simplified method of explaining the MESA-CAC cardiac risk status for the patients. In our study, coronary age was lower by more than 20 years versus chronological age for CAC percentiles between 0 and 50, almost equal with CAC percentile 51-75 and greater than chronological age by more than 10 years for CAC percentile &gt;75. Fig 1A: Distribution of coronary age classification compared to the chronological across the CACS percentiles 1B: Mean difference between coronary and chronological age across the CACS percentile